Myocardial Injury Associated with Transcatheter Aortic Valve Implantation

Most patients have elevated cardiac enzyme markers after uncomplicated TAVI, but higher levels may be associated with worse outcomes.

Little is known about adverse myocardial effects of transcatheter aortic valve implantation (TAVI), which may arise from hypotension (due to balloon valvuloplasty or rapid pacing), tissue compression during deployment, or ventricular puncture during transapical access. In this single-center Canadian study, investigators measured cardiac enzymes at multiple time points up to 72 hours after TAVI of a balloon-expandable prosthesis in 101 patients, 63 of whom had transapical access. Patients who died within 24 hours or had life-threatening procedural complications were excluded from the analysis.


Seventy-seven percent of all patients — 47% of those with transfemoral insertions and 95% of those with transapical insertions — had elevated creatine kinase (CK)-MB levels. The median maximal 24-hour CK-MB value was significantly higher with transapical than with transfemoral access (22.6 µL vs. 9.9 µL). In a multivariate analysis, transapical access was an independent predictor of a greater increase in CK-MB, and transapical access and renal dysfunction were independent predictors of a greater increase in cardiac troponin T (cTnT) level. The increase in enzyme markers did not differ between patients with and those without coronary artery disease (CAD). Incremental increase in cTnT was an independent predictor of cardiac mortality at a mean follow-up of 9 months. Improvement in left ventricular ejection fraction (LVEF) on echocardiography (performed at 6 and 12 months) declined slightly but significantly with greater increases in postprocedure enzyme levels.


Citation(s):

Rodés-Cabau J et al. Incidence, predictive factors, and prognostic value of myocardial injury following uncomplicated transcatheter aortic valve implantation. J Am Coll Cardiol 2011 May 17; 57:1988.